Top 46521 Justice Jobs

Supervisor, Focused Review
Delta Dental of Michigan —Okemos, MI
- Full-time
- Hybrid work
- 5 years
- Word processing
- Research
- Dental insurance
- Opportunities for advancement
Criminal Justice Specialist - (Huntsville) (2519)
Three Saints Bay, LLC —Huntsville, AL
- Bachelor of Science
- Mid-level
- Office
- On-the-job training
Quick Apply
Senior Inspectors or Lead Inspectors
Vander Weele Group LLC —Remote
- $36.00 - $50.48 an hour
- Full-time
- Remote
- 5 years
- English
- Ability to climb stairs
Quick Apply
Adjunct Faculty - Criminal Justice (on-line)
Kentucky Community and Technical College System —Bowling Green, KY
- $1,700 - $3,000 a month
- Part-time
- Remote
- 18 years or older
- Mid-level
- Master's degree
8d
Criminal Justice Specialist (2915)
Three Saints Bay, LLC —Wichita, KS
- Online Application
- Bachelor of Science
- Mid-level
- Driver's License
- On-the-job training
Quick Apply
Adjuncts - Criminal Justice
Northampton Community College —Bethlehem, PA
- Part-time
- Mid-level
- Master's degree
ADMINISTRATOR III SUPERVISOR (OIG Investigations Supervisor)
State of Maryland - DJS Office of the Secretary —Maryland
- $75,475 - $117,737 a year
- Online Application
- Military
- Writing skills
- Residential
Corrections Advisors/Instructors
Culmen International LLC —Remote
- Mid-level
- Master's degree
- Presentation skills
Adjunct Instructor in Criminal Justice
University of South Carolina —South Carolina
- Part-time
- 18 years or older
- Mid-level
- Master's degree
- Health insurance
- Flexible spending account
Staff Investigator
NOV Inc. —Houston, TX
- Full-time
- Background check
- Mid-level
- 3 years
U.S. Probation Officer (Court Services)
Florida Southern Probation and Pretrial Services —Florida
- $63,615 - $123,961 a year
- Microsoft Word
- Mid-level
U.S. Probation Officer - Investigations Unit
New York Northern Probation and Pretrial Services —Albany, NY
- $53,048 - $120,083 a year
- Weekends as needed
- Mid-level
- Office
- Travel
Child and Youth Justice Services Manager
Dept of Criminal Justice Svcs —Richmond, VA
- $110,000 - $116,000 a year
- Online Application
- Microsoft Excel
- Microsoft Outlook
- Office
8d
U.S. Pretrial Services & Probation Officer
Ohio Northern Probation and Pretrial Services —Akron, OH
- $49,361 - $121,535 a year
- Senior level
Part-time Faculty, Criminal Justice - Criminal Justice & Public Safety
Youngstown State University (OH) —Youngstown, OH
- Part-time
- Remote
- Mid-level
- University
Bilingual Clinical Supervisor (English/Spanish)
Bethany Christian Services USA LLC —Indianapolis, IN
- On call
- Spanish
- Current TB test
- Writing skills
- Wellness program
- 403(b) matching
Clinical Education Coordinator - Diagnostic Medical Sonography
Monroe University —Bronx, NY
- $80,000 - $90,000 a year
- Full-time
- Writing skills
- Clinic experience
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Board Certified Behavior Analyst (BCBA)
Justice Resource Institute —Taunton, MA
- $38 - $48 an hour
- Part-time
- Mid-level
- Residential
- Master's degree
- Health insurance
- Dental insurance
Quick Apply
Family Law Attorney - Survivor Representation Project
YWCA Union County/Family Justice Center —Elizabeth, NJ
- $85,000 a year
- Full-time
- Background check
- Spanish
- English
- Health insurance
- Dental insurance
Quick Apply
Family Engagement Clinician
INSTITUTE FOR HEALTH & RECOVERY —Cape Ann, MA
- $62,000 - $74,000 a year
- Full-time
- Hybrid work
- Spanish
- Clean driving record
- English
Quick Apply

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Supervisor, Focused Review

Delta Dental of Michigan -
Okemos, MI

Apply Now

Job Details

Full-time

Benefits

Dental insurance
Opportunities for advancement

Qualifications

Contract documentation review
Healthcare financial misconduct investigations
Contract review
Word processing
Spreadsheets
Contract interpretation
Research
Internal investigations
Health insurance knowledge
Healthcare billing investigations
Insurance investigations
Presentation preparation
Productivity software
Insurance (Financial sectors)
Technical Proficiency
Data analysis software

Full Job Description

Job Title:

Supervisor, Focused Review

Number of Positions:

Location:

Okemos, MI

Location Specifics:

Hybrid Position

Job Summary:

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description:

Plans, organizes, and supervises the Provider Auditor Focused Review Special Investigation Unit (SIU) , including oversight of data research and review, and audit and investigation activities. E nsures all team operations align with corporate and departmental goals and objectives, maintains compliance with applicable standards and policies, and supports continuous improvement in Focused Review processes.

Primary Job Responsibilities:

Supervises and monitors the daily administrative and technical functions of the Focused Review SIU teams, data research and review, and audit and investigation activities to ensure efficient, compliant operations that support departmental and corporate goals and objectives.
Supports staff recruitment, onboarding, and development by assisting with interviewing, training, mentoring, and evaluating team members to promote accountability and achievement of individual and team objectives.
Oversees staff engaged in data research, report development, and analytics, serving as a resource for audit and research questions and providing guidance to internal and external stakeholders on reporting issues, provider agreements, processing policies, client contracts, and regulatory compliance for both commercial and government programs.
Implements and enforces policies, procedures, and standards for audits and investigations, and assists in preparing departmental reports and analyzing business processes to ensure compliance with regulatory requirements for both commercial and government programs.
Facilitates communication with law enforcement and legal representatives by supporting the preparation of documentation and responses to subpoenas, and assisting with administrative or judicial proceedings related to fraud, waste, and abuse.
Builds and maintains collaborative relationships with business partners to provide operational support, clarify requirements, and promote effective use of SIU services and solutions.
Acts as a liaison for staff and internal departments, providing expertise and interpretation of dental policies, procedure codes, and processing guidelines related to claims adjudication, fraud, waste, and abuse activities.
Assists in developing and implementing departmental strategies, goals, and objectives to support continuous improvement and operational excellence.
Supports budget monitoring and resource allocation for the Focused Review SIU teams as directed by management.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

#LI-Hybrid

Minimum Requirements:

Position requires a bachelor’s degree in business administration , criminal justice, or related field a nd five years of experience conducting investigations, audit s, or complex data analy sis within the insurance industry. Previous leadership experience is preferred , as well as experience reviewing claims activity, provider behavior, or group contract compliance. Will accept any suitable combination of education, training, or experience.

Position requires advanced knowledge of the insurance industry operations; strong investigative skills related to fraud, waste, and abuse; proficiency with analytic al tools, word processing, spreadsheet, and presentation software skills; strong verbal and written communication skills, strong organizational and analytical skills; the ability to lead investigative teams ; the ability to interpret contract language and identify indicators of fraudulent activity ; the ability to manage multiple assignments with competing deadlines; and the ability to resolve complex problems using independent judgment. Professional certifications such as CFE, CIA, AHFI are preferred .

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

Apply Now

Refine Your Search

Justice jobs

Supervisor, Focused Review

Criminal Justice Specialist - (Huntsville) (2519)

Senior Inspectors or Lead Inspectors

Adjunct Faculty - Criminal Justice (on-line)

Criminal Justice Specialist (2915)

Adjuncts - Criminal Justice

ADMINISTRATOR III SUPERVISOR (OIG Investigations Supervisor)

Corrections Advisors/Instructors

Adjunct Instructor in Criminal Justice

Staff Investigator

U.S. Probation Officer (Court Services)

U.S. Probation Officer - Investigations Unit

Child and Youth Justice Services Manager

U.S. Pretrial Services & Probation Officer

Part-time Faculty, Criminal Justice - Criminal Justice & Public Safety

Bilingual Clinical Supervisor (English/Spanish)

Clinical Education Coordinator - Diagnostic Medical Sonography

Board Certified Behavior Analyst (BCBA)

Family Law Attorney - Survivor Representation Project

Family Engagement Clinician

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